Having graduated this year and having started as a brand new FY1, Dr Jr (Doctor Junior) has decided it may be a good idea to chronicle what happens, his views of the good old NHS from a fresh faced, bright eyed view as a junior doctor in the NHS.

Monday, 13 September 2010

Maintaining anonymity on a blog such as this allows someone like myself, working on the front-line, to tell the readers of my blog how things are on the shop-floor. The Daily Mail is a paper that annoys me, simply because it's sensationalist anti-NHS stance means that real concerns are drowned out but the drivel that comes. You'll find a real concern here.

Dr Jr was covering the wards this weekend. Never the nicest of jobs at the best of times, but for some reason, the hospital was heaving this weekend. The bed manager spent most of the weekend trying to close the hospital to new admissions due to bed pressure. On top of that, half the nursing staff phone in ill. What resulted was utter bedlam, for both staff, and the patients in the hospital.

In a hospital, I respect the nurses more than the doctors. A hospital could survive a week without doctors, most of the senior nursing staff are much more skilled and knowledgeable than many of the junior medics, such as myself; juniors (F1s and SHOs) also outnumber registrars and consultants. Even if patients went off completely, the critical care nurses would easily be able to bring them round. Short of internal surgical problems such as a massive bleed, most patients would survive. The reason I mention all this is when half the nursing staff are off ill, 2/3rds of the total patient care goes off too.

Now why are they all ill? Chronic understaffing. Understaffing to the level it's verging on dangerous, but not quite making it. Managers don't want to be in charge of a "dangerous" hospital, it means more work for them, maybe they'll even have to stay 15 minutes late once in a while. So just enough nurses so that all the essential stuff gets done and the actual bits of care that make such a huge difference to quality of stay (such as feeding, cleaning), just don't get done. When even one nurse goes ill, the whole tower of cards crumble, which stresses the working staff out to the point where they need time off. It's a cycle that continues onwards.

With some wards of upwards of 30 patients with just two qualified nurses covering them, Juniorville Hospital was sheer bedlam. The bed manager was trying to clear as many patients as she could, she directly told me "it's safer out on the street than it is in here this weekend". Oh dear.

Meanwhile, in my side, I had already worked all week and was covering 13 hour shifts over the weekend. It got worse when a registrar and SHO called in sick on AAU and I had to end up covering them both. Yes, a lone F1 covering the job of a SHO and a registrar.

Is this normal show across the land? To be so short staffed on the nursing front and requiring medical staff to frequently change firms because they can't employ enough to cover a team over their rotations? It definitely wasn't where I trained. What worries me more is posts like this from PC Bloggs, who presents a similar picture from our on the beat friends over at the local nick. When you see what cuts have done over there, you just fear for the NHS. I don't believe a single word the government says about ringfencing. The axe will come, and when it comes, as always, it's the front-line staff who take first blood. If my hospital is anything to go by, we are in big, big trouble.

Empassioned bleating that restricting junior doctor hours to 48 a week completely miss the point. The problem is the shortage of nursing staff. The 48 hour week doesn't help situations mind, but if you want more work from doctors, where's the money going to come from to pay them for the extra 12 hours a week they'll probably end up working? If hospitals instead bothered to bolster their nursing staff, they would spend less money due to the lack of need to bring in much more expensive bank staff, especially when nursing stress went down and they didn't have to go off ill as a result.

This is when being in hospital is more dangerous. I fear we're heading that direction if we don't stop this cart now and what's worse, I think the brakes on this thing are shot.

8 comments:

Great post Dr Jr, but I don't think you are alone. It happens over in my gaff as well. More patients but no more beds or staff, something's got to give. It won't come the BMA, the single most useless union in existence.

http://militantmedicalnurse.blogspot.com/

MMN gives a great ranty account of your problem from a nursing point of view.

Please take care about what you write on a blog about your place of work. I hear most NHS contracts have a clause that states that an employee must not bring the hospital to disrepute or something meaning that. If anything you write here identifies that place of work "nurse saying it was safer on the street" and it can be traced to you, you would get into trouble.

"...I had already worked all week and was covering 13 hour shifts over the weekend. It got worse when a registrar and SHO called in sick on AAU and I had to end up covering them both. Yes, a lone F1 covering the job of a SHO and a registrar.

Sounds like my F1 year, on-call in medicine was 13hr weekend shifts in addition to usual working hours during both weeks either side (including another 4-5 13hr on-call days) and on my first full on-call in the medical admissions unit I was met by the consultant on his way out who said 'I'm afraid it's just you this evening, patient in bed 2 needs a lumbar puncture, good luck!'

Ah, happy days. The NHS, never knowingly doing things safely that could be done more cheaply and dangerously.

Everybody sticks up for the nurses and appreciate the great work they do. Everybody also knows that their work is not remunerated properly and that they should be paid better, but they have a formidable union who really sticks up for them and fights for their rights even to the point of taking the government to court as is currently happening. Nobody sticks for the juniors, not even their so called union, to the point that their pay and conditions have gone down so much that age for age, a nurse is much better off than a junior doctor who spent double the time and effort preparing. This is not fair.

Dr Jr versus Admin: The Running Score

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Content copyright to the author(s). Content not to be used in the commercial media or for profit without prior consent. Names and places changed to protect patient confidentiality. All of the blog is a true account of life on the wards. I think.